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2014-2015

DOUGLASS ACADEMY APPLICATION FOR STUDENT ENROLLMENT

Student Information: *Grade Applying For :(Proof of last grade level completed will be required)

Student's Name:

Date of Birth: Age:
(Kindergarten students must be 5 years old by August 31, 2014)

Street Address:

Mailing Address:
(if different from above)

Family Information:

Father/Guardian:Name:

Relationship to Child:

Address:

Contact Number 1: ###-###-####

Contact Number 2: ###-###-####

E-mail Address:

Mother/Guardian:Name:

Relationship to Child:

Address:

Contact Number 1: ###-###-####

Contact Number 2: ###-###-####

E-mail Address:

Additional Information:

1. Is this applicant the child of a Douglass Academy staff member?
Yes
No
If yes, staff member's name:

2. Does this applicant have a sibling who is currently enrolled in Douglass Academy that lives in the same household (includes half sibs, step-sibs, children residing in family foster home)?
Yes
No
If yes, current student's name and grade:
Grade:

3. Has this applicant previously attended Douglass Academy?
Yes
No
If yes, what was the reason for leaving and date of withdrawal?

(MM/YYYY) (Will not affect equal opportunity at lottery but may allow priority per G.S. 115C-238.29F)

4. Does this applicant have sibling(s) that live in the same household who are also applying to attend Douglass Academy for the 2014-15 school year?
Yes
No
(Note: Entering siblings will be placed together as a surname in the lowest grade level that is being applied. If the surname is selected in the case of a lottery, all siblings shall be admitted to the extent that space is available.)

Verification Statement: I am the legal Guardian of the above student applicant and verify that all information provided is true and accurate to the best of my knowledge.

Note: It is important that you notify the school if any phone numbers change. If your child is placed on the waiting list, we will attempt to call all available numbers if a space becomes available.

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